Methods, devices, and systems for blood flow

ABSTRACT

Various exemplary methods, systems, and devices for blood flow are provided. In general, an implant can be configured to be implanted in bone and to delay clotting of blood flowing from the bone. The implant can include an anti-coagulation agent to delay the clotting of the blood. The anti-coagulation agent can be a coating on the implant, can be natural to a material forming the implant, or can be impregnated into a material forming the implant. In an exemplary embodiment, the implant is implanted in a bone in a surgical procedure for securing a soft tissue to bone, such as a rotator cuff repair procedure or an anterior cruciate ligament (ACL) repair procedure.

FIELD

The present disclosure relates generally to methods, systems, anddevices for blood flow.

BACKGROUND

Soft tissues, such as ligaments, tendons, and muscles, are attached to alarge portion of the human skeleton. In particular, many ligaments andtendons are attached to the bones which form joints, such as shoulderand knee joints. A variety of injuries and conditions require attachmentor reattachment of a soft tissue to bone and/or surrounding tissue. Forexample, when otherwise healthy tissue has been torn away from a bone,surgery is often required to reattach the tissue to the bone to allowhealing and a natural reattachment to occur.

One example of otherwise healthy tissue being torn away from a bone is arotator cuff tear in which a shoulder rotator cuff tendon is partiallyor completely torn from a humerus. Surgery to reattach the rotator cufftendon to the humerus has a failure rate as high as 40%. One way thathas been developed to help reduce this failure rate is to add blood tothe repair site to aid in and improve the healing process, as bloodincludes healing factors. One method to add blood is to decorticate orotherwise scuff the bone having the tendon attached thereto to inducesome bleeding in the bone. Another method to add blood is to createmicrofracture holes in the bone having the tendon attached thereto tocause blood to “weep” from the microfracture holes. However, the bloodclots within a short amount of time after the decortication, scuffing,or microfracture, typically within minutes or hours, so there is alimited amount of blood added to the repair site, which may limit theadded blood's healing effects, and the blood is only added for a shorttime after the bone is decorticated, scuffed, or microfractured duringthe performance of the surgical procedure, which may not promote longterm healing.

Accordingly, there remains a need for improved methods and devices formethods, systems, and devices for blood flow.

SUMMARY

In general, methods, systems, and devices for blood flow are provided.

In one aspect, a surgical device is provided that in one embodimentincludes a biocompatible tubular member configured to be implanted in abone of a patient. The tubular member has a solid sidewall defining aninner lumen extending through the tubular member such that blood canflow into the inner lumen through a first open end of the inner lumenand out of the inner lumen through a second open end of the inner lumen.The tubular member includes an anti-coagulation agent on the solidsidewall.

The surgical device can vary in any number of ways. For example, theinner lumen can be open and free of occlusions. For another example, theinner lumen can have a bioabsorbable material disposed therein thatoccludes the inner lumen such that the blood cannot flow out of theinner lumen through the second open end of the inner lumen until thebioabsorbable material has been at least partially absorbed by thepatient's body. For yet another example, the tubular member can includea retaining member configured to engage the bone in which the tubularmember is implanted to retain the tubular member within the bone. Forstill another example, the anti-coagulation agent can be coated on asurface of the solid sidewall. For another example, the anti-coagulationagent can be impregnated in a material forming the solid sidewall. Forstill another example, the anti-coagulation agent can include at leastone of heparin, heparin sulfate, warfarin, hirudin, hirulog, coumarin,phosphorylcholine, indiandione, antithrombin III, bemiparin, dalteparin,danaparoid, enoxaparin, nadroparin, parnaparin, reviparin, sulodexide,tinzaparin, anticoagulant citrate dextrose solution A (ACD-A),ethylenediaminetetraacetic acid (EDTA), citrate, oxalate, a factor Xainhibitor, and a thrombin inhibitor. For another example, the tubularmember can be bioabsorbable. For yet another example, the tubular membercan be non-bioabsorbable. For still another example, the tubular membercan have a first retaining member configured to engage the bone in whichthe tubular member is implanted to resist distal advancement of thetubular member into the bone, and the tubular member can have a secondretaining member spaced apart from the first retaining member andconfigured to engage the bone in which the tubular member is implantedto resist proximal advancement of the tubular member from the bone.

For another example, the inner lumen can have a plug removably disposedtherein that occludes the inner lumen such that the blood cannot flowout of the inner lumen through the second open end of the inner lumenuntil the plug is removed from the inner lumen, and the plug can beconfigured to be implanted in the patient with the tubular member. In atleast some embodiments, the plug can be made from an energy activatedmaterial disposed therein that occludes the inner lumen until the energyactivated material is activated by application of energy thereto. In atleast some embodiments, the plug can be a knitted material that occludesthe inner lumen until the knitted material is pulled to cause theknitted material to unravel. In at least some embodiments, the plug canhave a suture extending therefrom. The suture can be configured toextend from inside the patient's body to outside the patient's body andto be pulled from outside the patient's body and thereby remove the plugfrom the inner lumen of the tubular member.

In another embodiment, a surgical device includes a biocompatible anchorconfigured to be implanted in a bone of a patient. The anchor has atleast one bone-engaging surface feature on an exterior surface thereofthat is configured to engage the bone to secure the anchor in the bone.The anchor has an inner lumen extending therethrough such that blood canflow into the inner lumen through a first open end of the inner lumenand out of the inner lumen through a second open end of the inner lumenwhen the anchor is implanted in the bone. The anchor includes ananti-coagulation agent.

The surgical device can have any number of variations. For example, theanti-coagulation agent can be coated on a surface of the anchor. Foranother example, the anti-coagulation agent can be impregnated in amaterial forming the anchor. For yet another example, theanti-coagulation agent can include at least one of heparin, heparinsulfate, warfarin, hirudin, hirulog, coumarin, phosphorylcholine,indiandione, antithrombin III, bemiparin, dalteparin, danaparoid,enoxaparin, nadroparin, parnaparin, reviparin, sulodexide, tinzaparin,anticoagulant citrate dextrose solution A (ACD-A),ethylenediaminetetraacetic acid (EDTA), citrate, oxalate, a factor Xainhibitor, and a thrombin inhibitor. For still another example, a suturecoated with or impregnated with an anti-coagulation agent can be coupledto the anchor. For another example, the anchor can have a solid sidewalldefining an inner lumen through which the blood flows. For yet anotherexample, the anchor can have at least one hole formed through a sidewallthereof, and the at least one hole can be in communication with theinner lumen such that the blood can flow into the inner lumen throughthe hole.

In another aspect, a surgical method is provided that in one embodimentincludes forming a hole in a bone of a patient in a soft tissue repairprocedure, and implanting an implant in the hole. The implant includesan anti-coagulation agent. The implanted implant allows blood to flowtherethrough.

The surgical method can vary in any number of ways. For example, theimplant can be an anchor, and the anchor can have at least onebone-engaging surface feature on an exterior surface thereof thatengages the bone to secure the anchor in the hole. For another example,the implant can be a tubular member, and the inner lumen can be open andfree of occlusions when the implant is implanted in the hole such thatthe blood is allowed to begin flowing through the implanted implantbefore completion of the soft tissue repair procedure. For still anotherexample, the method can include implanting an anchor in the bone at asite a distance away from a site where the implant is implanted, and theimplant can be a tubular member that is not connected to the anchor withany implanted matter. For another example, the implant can have a solidsidewall defining an inner lumen through which the blood flows. For yetanother example, the implant can have at least one hole formed through asidewall thereof, and the at least one hole can be in communication withan inner lumen of the implant through which the blood flows such thatthe blood can flow into the inner lumen through the hole.

For yet another example, the implant can be a tubular member, and theinner lumen can be occluded when the implant is implanted in the holesuch that the blood is prevented from flowing through the implantedimplant until a selected amount of time has lapsed after completion ofthe soft tissue repair procedure. The method can also include removing aplug from within the inner lumen of the implanted tubular member andthereby allow blood to begin flowing through the implanted tubularmember, or the implanted tubular member can have bioabsorbable materialdisposed in the inner lumen that occludes the inner lumen until thebioabsorbable material is at least partially absorbed by the patient'sbody after the selected amount of time has lapsed after completion ofthe soft tissue repair procedure.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of an implant;

FIG. 2 is another perspective view of the implant of FIG. 1 withdirectional flow arrows;

FIG. 3 is a perspective partially transparent view of one embodiment ofthe implant of FIG. 1 implanted in a patient;

FIG. 4 is a side partially cross-sectional view of the implant of FIG. 3implanted in the patient;

FIG. 5 is a perspective view of one embodiment of an implant including aplug disposed therein;

FIG. 6 is a perspective view of the implant of FIG. 5 with directionalflow arrows and with the plug removed therefrom;

FIG. 7 is a perspective view of another embodiment of an implantincluding a plug disposed therein;

FIG. 8 is a perspective view of the implant of FIG. 7 with directionalflow arrows and with the plug removed therefrom; and

FIG. 9 is a perspective partially transparent, partially cross-sectionalview of another embodiment of an implant implanted in a patient;

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various exemplary methods, systems, and devices for blood flow areprovided. In general, an implant can be configured to be implanted inbone and to delay clotting of blood flowing from the bone. The implantcan include an anti-coagulation agent to delay the clotting of theblood. The anti-coagulation agent can be a coating on the implant, canbe natural to a material forming the implant, or can be impregnated intoa material forming the implant. Although the anti-coagulant agent can beformed on a portion of the implant over which blood flows, theanti-coagulant agent can be present on an entire surface of the implant.In an exemplary embodiment, the implant is implanted in a bone in asurgical procedure for securing a soft tissue to bone, such as a rotatorcuff repair procedure or an anterior cruciate ligament (ACL) repairprocedure. The implant delaying the clotting of blood flowing from thebone may lengthen an amount of time the blood flows from the bone (ascompared to the implant being implanted without the implant includingthe anti-coagulation agent and as compared to the implant not beingimplanted at all), which may aid in and improve the healing process byincreasing an amount of blood that flows to the repair site and henceincreasing a chance of the surgical procedure's success. The implantdelaying the clotting of blood flowing from the bone may allow the bloodto begin flow at a selected time after the surgical procedure has ended,which may aid in and improve the healing process by adding blood flow tothe repair site at a time subsequent to when blood would have alreadyclotted if the blood flow had begun during the surgical procedure (e.g.,by decorticating, scuffing, or microfracturing the bone during thesurgical procedure to induce blood flow).

The implants described herein can include any of a varietyanti-coagulation or nonthrombogenic agents. Exemplary anti-coagulationagents include heparin, heparin sulfate, warfarin, hirudin, hirulog,coumarin, phosphorylcholine, indiandione, antithrombin III, bemiparin,dalteparin, danaparoid, enoxaparin, nadroparin, parnaparin, reviparin,sulodexide, tinzaparin, anticoagulant citrate dextrose solution A(ACD-A), ethylenediaminetetraacetic acid (EDTA), citrate, oxalate,factor Xa inhibitors, thrombin inhibitors, and other factor inhibitorsor derivatives thereof. The implant's anti-coagulation agent can includea single anti-coagulation agent or a combination of multipleanti-coagulation agents.

The implants described herein can be made from any of a variety ofmaterials. In some embodiments, the implant can be made from anon-bioabsorbable material (a single non-bioabsorbable material or acombination of multiple non-bioabsorbable materials) such that theimplant is non-bioabsorbable. Exemplary non-bioabsorbable materialsinclude polyetheretherketone (PEEK), polysulfone, polyester, silicone,and metals (e.g., stainless steel, titanium, etc.). In otherembodiments, the implant can be made from a bioabsorbable material (asingle bioabsorbable material or a combination of multiple bioabsorbablematerials) such that the implant is bioabsorbable. A rate of abioabsorbable implant's absorption can be tailored based on a size(length and/or diameter) of the implant and a type of bioabsorbablematerial forming the implant since different materials can absorb atdifferent rates. Exemplary bioabsorbable materials include polylacticacid (PLA), polyglycolic acid (PGA), Biocryl® Rapide available fromDePuy Mitek of Raynham, Mass., a resorbable metal (e.g., magnesium,zinc, iron, and alloys thereof), aliphatic polyesters, poly(aminoacids), copoly(ether-esters), polyalkylene oxalates, polyamides,tyrosine derived polycarbonates, poly(iminocarbonates), polyorthoesters,polyoxaesters, polyamidoesters, polyoxaesters containing amine groups,poly(anhydrides), polyphosphazenes, polyurethanes, poly(etherurethanes), poly(ester urethanes), poly(propylene fumarate),poly(hydroxyalkanoate) and polydioxanone (PDS). Examples of aliphaticpolyesters include homopolymers and copolymers of lactide (whichincludes lactic acid, D-, L- and meso lactide); glycolide (includingglycolic acid); epsilon-caprolactone; p-dioxanone (1,4-dioxan-2-one);trimethylene carbonate (1,3-dioxan-2-one); alkyl derivatives oftrimethylene carbonate; delta-valerolactone; beta-butyrolactone;gamma-butyrolactone; epsilon-decalactone; hydroxybutyrate;hydroxyvalerate; 1,4-dioxepan-2-one (including its dimer1,5,8,12-tetraoxacyclotetradecane-7,14-dione); 1,5-dioxepan-2-one;6,6-dimethyl-1,4-dioxan-2-one; 2,5-diketomorpholine; pivalolactone;alpha,alpha diethylpropiolactone; ethylene carbonate; ethylene oxalate;3-methyl-1,4-dioxane-2,5-dione; 3,3-diethyl-1,4-dioxan-2,5-dione;6,6-dimethyl-dioxepan-2-one; 6,8-dioxabicycloctane-7-one, and polymerblends thereof. Additional examples of polymer or polymer blends includea polydioxanone, a polyhydroxybutyrate-co-hydroxyvalerate,polyorthocarbonate, a polyaminocarbonate, and a polytrimethylenecarbonate. The aliphatic polyesters can be homopolymers or copolymers(random, block, segmented, tapered blocks, graft, triblock, etc.) havinga linear, branched or star structure. Whether bioabsorbable ornon-bioabsorbable, the implants described herein are biocompatible toallow for their safe implantation in patients.

The implants described herein can include a biocompatible ceramicmaterial. Exemplary biocompatible ceramic materials includehydroxyapatite, alpha-tricalcium phosphate, beta-tricalcium phosphate,bioactive glass, calcium phosphate, calcium sulfate, calcium carbonate,xenogeneic and allogeneic bone material, and combinations thereof.Exemplary bioactive glass materials include silicates containing calciumphosphate glass, and calcium phosphate glass with varying amounts ofsolid particles added to control resorption time. Exemplary compoundsthat can be incorporated into the calcium phosphate bioactive glassinclude, magnesium oxide, sodium oxide, potassium oxide, andcombinations thereof.

FIG. 1 illustrates one embodiment of an implant 10 configured to beimplanted in bone and to delay clotting of blood flowing from the bone.The implant 10 is a tubular member in the form of a tube and has aninner lumen 12 extending between proximal and distal ends 14, 16thereof. The proximal and distal ends 14, 16 are thus open ends. Theinner lumen 12 allows fluid (e.g., blood) to flow through the implant 10when the implant 10 is implanted in a body of a patient (e.g., in a boneof a patient). Arrows 18 in FIG. 2 illustrate a distal-to-proximaldirection of possible fluid flow through the implant 10. Fluid flowthrough the implant 10 in use is discussed further below.

The inner lumen 12 is open and free of occlusions. The inner lumen 12may thus provide a continuous flow path through the implant 10 and maydo so immediately upon implantation in a body of a patient, which mayallow fluid to begin immediately flowing through the implant 10. Theinner lumen 12 is defined by an inner surface 20 of the implant 10(e.g., an inner sidewall thereof). The inner lumen 12 has a cylindricalshape and a circular cross-sectional shape in this illustratedembodiment, which may facilitate fluid flow therethrough and/or helpprevent the inner lumen 12 from clogging. However, other shapes (e.g.,cone-shaped, etc.) and other cross-sectional shapes (e.g., ovalcross-sectional shape, etc.) are possible. The inner surface 20 issolid. The solid nature of the inner surface 20 allows that, once fluidenters the inner lumen 12 through either the inner lumen's open proximalend or open distal end, the fluid cannot exit the implant 20 through theinner surface 20 (e.g., through pore(s) or window(s) formed in the innersurface 20). Instead, the fluid can only exit the inner lumen 12 throughthe open proximal end or open distal end. Similarly, the solid nature ofthe inner surface 20 provides that fluid can only enter the inner lumen12 through the open proximal end or the open distal end. Fluid may thuspredictably flow through the inner lumen 12 and thereby help ensure thatthe fluid flows to an intended site (e.g., that blood flows through theinner lumen 12 to an intended tissue repair site). The inner surface 20is smooth and free of protrusions, indentations, and other obstructionsthereon or therein, which may facilitate fluid flow through the innerlumen 12 and/or help prevent the inner lumen 12 from clogging.

In other embodiments, an inner surface of an implant that defines aninner lumen of the implant can have one or more openings formedtherethrough. The one or more openings can each be in communication withthe inner lumen. Fluid can thus flow into the inner lumen through theone or more openings. The implant can have an open distal end such thatfluid can enter the inner lumen through an opening at the open distalend and through the one or more openings, or the implant can have aclosed distal end such that fluid cannot enter the inner lumen throughthe implant's distal end but can enter the inner lumen through the oneor more side openings of the implant.

Referring again to FIG. 1, the inner lumen 12 is straight and is alignedwith a longitudinal axis A of the implant 10. The inner lumen 12 can,however, be offset radially from the longitudinal axis A and/or becurved relative to the longitudinal axis A.

The implant 10 includes at least one retaining member configured toengage a bone in which the implant 10 is implanted to retain the implant10 therein. The retaining member(s) can have a variety of sizes, shapes,and configurations. In this illustrated embodiment, the implant 10includes a proximal retaining member 22 and a distal retaining member24.

The proximal retaining member 22 is configured to prevent the implant 10from moving distally once the proximal retaining member 22 engages thematter in which the implant 10 is implanted (e.g., engages a proximalsurface of a bone having a hole formed therein in which the implant 10is disposed). In other words, the proximal retaining member 22 isconfigured to prevent the implant 10 from advancing too far distally inbone (or other matter in which the implant 10 is implanted), which mayalso help a surgeon or other user implanting the implant 10 know whenthe implant 10 has been fully distally advanced into the bone (or othermatter). A distal surface of the proximal retaining member 22 isconfigured to engage the matter. The proximal retaining member 22extends radially outward from the implant's proximal end 14, therebyallowing the proximal end 14 of the implant 10 to have a diameter thatis greater than a diameter of a body 26 of the implant 10. The body 26can thus be configured to be disposed in matter in which the implant 10is implanted while the proximal retaining member 22 remains outside ofthe matter. The proximal retaining member 22 is in the form of a flangeextending radially outward from the proximal end 14 of the implant 10.The flange has a circular ring shape and extends around an entireperimeter of the implant's proximal end 14. The flange can, however,have other shapes (e.g., oval, triangular, etc.) and can bediscontinuous around the perimeter of the implant's proximal end 14(e.g., a series of independent flange members extending radially outwardfrom the implant's proximal end 14, a single tab extending radiallyoutward from the implant's proximal end 14, etc.). The proximalretaining member 22 extending around the entire perimeter of theimplant's proximal end 14 may help ensure that the proximal retainingmember 22 engages a surface of the matter (e.g., bone) in which theimplant 10 is implanted.

The distal retaining member 24 is configured to prevent the implant 10from moving proximally once the distal retaining member 24 engages thematter in which the implant 10 is implanted (e.g., engages a distalsurface of a bone having a hole formed therein in which the implant 10is disposed). Depending on use of the implant 10, the distal retainingmember 24 can also be configured to prevent the implant 10 from movingdistally once the distal retaining member 24 engages the matter in whichthe implant 10 is implanted. In other words, if the distal retainingmember 24 is contained within the matter in which the implant 10 isimplanted, as opposed to being located outside of the matter like theproximal retaining member 22, the distal retaining member 24 can beconfigured to prevent both proximal and distal movement of the implant10 within the matter. The distal retaining member 24 is in the form of aprotrusion extending radially outward from the body 26 of the implant 10near the implant's distal end 16. The protrusion has a circular ringshape and extends around an entire perimeter of the implant's body 26.The protrusion can, however, have another shape (e.g., oval, triangular,etc.) and can be discontinuous around the perimeter of the implant'sbody 26 (e.g., a series of independent protrusions extending radiallyoutward from the implant's body 26, a single protrusion extendingradially outward from the implant's body 26, etc.).

The proximal and distal retaining members 22, 24 are configured tocooperate to retain the implant 10 within the matter in which theimplant 10 is implanted. In other words, the proximal retaining member22 is configured to prevent distal movement of the implant 10 within thematter and the distal retaining member 24 is configured to preventproximal movement 10 of the implant 10 within the matter (and, in atleast some embodiments, to also prevent distal movement 10 of theimplant 10 within the matter). In an exemplary embodiment, a distance Dbetween the proximal and distal retaining members 22, 24 corresponds toa depth of cortical bone of a bone in which the implant 10 may beimplanted. In this way, the implant 10 can be configured to “trap” thecortical bone between the proximal and distal retaining members 22, 24,thereby allowing the implant 10 to grip the harder cortical bone ratherthan the softer cancellous bone that underlies the cortical bone. In anexemplary embodiment, the distance D is in a range of about 0.05 to 100mm.

The implant 10 includes both of the proximal and retaining members 22,24 in this illustrated embodiment, but an implant can include only oneof the proximal and retaining members 22, 24. Alternatively, an implantcan include both of the proximal and retaining members 22, 24 and one ormore additional retaining members along a length of the implant's bodythat are similar to the distal retaining member such that the body has aplurality of protrusions at different axial positions therealong, or animplant can lack the proximal retaining member 22 and can include thedistal retaining member 24 and one or more additional retaining membersalong a length of the implant's body that are similar to the distalretaining member such that the body has a plurality of protrusions atdifferent axial positions therealong. An implant having the distalretaining member 24 and one or more additional retaining members similarthereto like may help ensure that at least one retaining member securelyengages the matter in which the implant is implanted.

The distal end 16 of the implant 10 can be configured to facilitateinsertion of the implant 10 into matter in a distal direction, whichwould be the typical approach direction for the implant's implantation.The distal end 16 of the implant 10 is angled to facilitate insertion ofthe implant 10 into matter, e.g., into bone in which the implant 10 willbe implanted. The angled distal end can be sharp to further tofacilitate insertion of the implant 10 into the matter. In otherembodiments, a distal end of an implant can be non-angled, similar tothe proximal end 14 of the implant 10.

The implant 10 includes an anti-coagulation agent configured to preventor delay coagulation of blood, e.g., to prevent or delay clotting. Alength of time that the anti-coagulation agent prevents the blood fromcoagulating is generally a function of a type of the anti-coagulationagent and an amount of the anti-coagulation agent that is present, aswill be appreciated by a person skilled in the art. In an exemplaryembodiment, the length of time blood encountering the anti-coagulantagent flows before coagulating is in a range of about one to threehundred minutes, e.g., in a range of about four to twenty minutes, in arange of about four to fifteen minutes, in a range of about fifteen totwenty minutes, etc.

The anti-coagulation agent is coated on the implant 10 in theillustrated embodiment. The anti-coagulation agent is coated on anentirety of the implant's exposed surface, including on the innersurface 20 and on the implant's outer surface 28, which may help ensurethat any blood that comes into contact with the implant 10 is encouragedto flow and not clot. Similarly, each of an implant including ananti-coagulation agent as natural to a material forming the implant andan implant including an anti-coagulation agent impregnated into amaterial forming the implant encourages any blood that comes intocontact with the implant to flow and not clot. In other embodiments, animplant can have an anti-coagulation agent coated on only a partialportion thereof. For example, the anti-coagulation agent can be coatedonly on an inner surface of an implant (e.g., the inner surface 20 ofthe implant 10), which may help encourage blood flowing through theimplant's inner lumen toward a tissue repair site to not clot afterexiting the implant. Similarly, an implant including an anti-coagulationagent as natural to a material forming the implant can include thatmaterial in only a portion of the implant (such as only in the implant'sbody or only along an inner surface defining an implant's inner lumen),and an implant including an anti-coagulation agent impregnated into amaterial forming the implant can include that material in only a portionof the implant (such as only in the implant's body or only along aninner surface defining an implant's inner lumen). The coating of theanti-coagulation agent, whether coated on an entirety of the implant'sexposed surface or on only a partial portion of the implant's exposedsurface, is, in at least some embodiments, a gradient coating.

In use, the implant 10 and other implants disclosed herein can be usedin any number of a variety of surgical procedures and can be driven intoa bone in the surgical procedure. For example, the surgical procedurecan include a soft tissue repair procedure for securing a soft tissue tobone, such as a rotator cuff repair, Achilles, or ACL repair procedure.

In general, a surgical procedure can be performed as it would betypically performed on a patient except that an implant is implanted ina bone adjacent a target site in which blood flow is desired tofacilitate healing, such as in a bone adjacent to a soft tissuereattachment site. A single implant can be implanted in the patient, ora plurality of implants can be implanted in the patient. If a pluralityof implants are implanted, each of the implants can be identical to oneanother or any one or more of the implants can differ from any one ormore of the other implants, e.g., have different sizes, includedifferent anti-coagulation agents, etc.

FIGS. 3 and 4 illustrate one embodiment of use of the implant 10. Otherimplants disclosed herein can be similarly used. FIGS. 3 and 4illustrate the implant 10 implanted in a humerus 30 of a patient 32 inrotator cuff repair. Only one of the implants 10 is implanted in thebone 30, but as mentioned above, more than one implant can be implanted.When a plurality of implants are implanted, at least one of the implantscan have an unoccluded inner lumen, like the implant 10, to allow forblood flow therethrough at a time of surgery, and at least one of theimplants can have an occluded lumen (for example, the implants of FIGS.5-8 discussed below) to allow for blood flow therethrough at a timeafter the surgery. More blood may thus be allowed to flow at the softtissue reattachment site 34 throughout the healing process.Alternatively, when a plurality of implants are implanted, all of theimplants can have an occluded lumen and be configured to have its lumenunoccluded at different times post-surgery, e.g., by plugs in thevarious inner lumens being removed at different times manually ornaturally via absorption.

As mentioned above, the rotator cuff procedure can be performed as itwould be typically performed on a patient except that the implant 10 isimplanted in a bone (the humerus 30) adjacent to the soft tissuereattachment site 34, which here is where a rotator cuff tendon 36 issecured to the humerus 30 using sutures 38 and anchors (obscured in thebone 30 under the tendon 36). The implant 10 is implanted lateral to thetendon 36, but instead the implant 30 can be implanted under the tendon36.

In an exemplary embodiment, the implant 10 is implanted after therotator cuff tendon 36 is secured to the humerus 30, which may allow therotator cuff tendon 36 to be secured to the humerus 30 without theimplant 10 interfering with the securing process.

FIG. 4 illustrates the distance D between the proximal and distalretaining members 22, 24 as corresponding to a depth of cortical bone 40of the humerus 30 with the proximal retaining member 22 engaging aproximal surface of the cortical bone 40 (and hence a proximal surfaceof the humerus 30) and the distal retaining member 24 engaging a distalsurface of the cortical bone 40. FIG. 4 also illustrates blood 42flowing in a proximal direction, as indicated by arrow 44, through theinner lumen 12 with the blood 42 entering the implant 10 through theimplant's open distal end and exiting the implant 10 through theimplant's open proximal end. FIG. 3 also shows the exiting of the blood42 from the implant 10. The blood 42 may thus flow in a direction towardthe tissue reattachment site 34 and encourage healing thereat.

The implant 10 can be implanted in the humerus 30 in any of a variety ofways, as will be appreciated by a person skilled in the art. Forexample, the implant 10 can be advanced into the patient in a minimallyinvasive fashion through the patient's skin 44 and driven into thehumerus 30 similar to the driving of the anchors into the humerus 30,e.g., by using a driver tool to push the implant 10 into the humerus 30.

FIGS. 5 and 6 illustrate another embodiment of an implant 46 configuredto be implanted in bone and to delay clotting of blood flowing from thebone. The implant 46 is a tubular member in the form of a tube. Theimplant 46 is generally configured and used similar to the implant 10 ofFIG. 1, e.g., includes an inner lumen 48 defined by a solid innersurface 50 of the implant 46 and aligned with a longitudinal axis A2 ofthe implant 46, a proximal retaining member 52 in the form of a flange,a distal retaining member 54 in the form of a ring-shaped protrusion, anangled distal end 56, and an anti-coagulation agent in the form of acoating that coats an entirety of the implant's exposed surface.

The inner lumen 48 of the implant 46 of FIGS. 5 and 6 is occluded in afirst configuration of the implant 46, shown in FIG. 5. Fluid cannotflow through open proximal and distal ends of the implant 46 in thefirst configuration due to the occlusion. Fluid can enter the innerlumen 48 through the implant's open distal end, but the occlusionprevents the fluid's exit from the implant 48 through the proximal openend. In other embodiments, fluid can be prevented from entering animplant's inner lumen at all due to an occlusion in the implant's innerlumen. The implant 48 is configured to move from the first configurationto a second configuration, shown in FIG. 6, in which the inner lumen 48is not occluded. The implant 46 in the second configuration is thus likethe implant 10 of FIG. 1 with its inner lumen 48 being open and free ofocclusions. Arrows 58 in FIG. 6 shows a distal-to-proximal direction ofpossible fluid flow through the implant 46 in the second configuration.In another embodiment, the implant in the second configuration can bepartially open and partially occluded so as to allow fluid flowtherethrough while a portion of the plug remains in the implant's innerlumen.

The implant 46 is configured to be implanted in a patient in the firstconfiguration and to be moved from the first configuration to the secondconfiguration after the implantation. The implant 46 is configured tomove from the first configuration to the second configuration at aselected time after the implantation of the implant 46 in a patient.Fluid can thus begin to flow through the implant 46 at a selected time,which may allow blood flow at an intended surgical site to begin at atime selected by a doctor or other medical professional as desired basedon any one or more factors, such as the patient's medical history, thedoctor's/professional's personal preference, etc. In at least someembodiments, the selected time is after completion of the surgicalprocedure in which the implant 46 is implanted in a patient. The bloodflow may thus begin post-surgery, which may help accelerate and/orotherwise improve healing post-surgery. The selected time can vary. Forexample, the selected time can be a time in a range of one day toseveral days, in a range of one day to one week, one week, or in a rangeof two weeks to four weeks (e.g., two weeks after surgery, twenty daysafter surgery, four weeks after surgery, etc.). In other embodiments,the selected time is at or near an end of the surgical procedure inwhich the implant 46 is implanted in a patient, e.g., as a last step ofthe procedure before access to the patient is closed (e.g., an accessportal incision into the patient is closed, etc.). The blood flow maythus begin as late as possible in the surgery.

As shown in FIG. 5, the inner lumen 48 of the implant 46 is occluded bya plug 60 that is at least partially disposed in the inner lumen 48. Theplug 60 is fully contained within the inner lumen 48 in this illustratedembodiment. The plug 60 being fully contained within the inner lumen 48may help minimize a profile of the implant 48 and thereby help preventthe implant 48 from poking into, rubbing against, or otherwisedisturbing tissue structures near the implant 48 when implanted in apatient. In other embodiments, a plug of an implant can be partiallyoutside of the implant when the implant is in its first configuration,e.g., a proximal portion of the plug can extend proximally beyond aproximal end of the implant. The plug being partially contained withinthe inner lumen may make the plug easier to remove from the implant.

The plug 60 can have a variety of sizes, shapes, and configurations. Ingeneral, the plug 60 has a size and shape that allows the plug 60 toocclude the inner lumen 48 so fluid cannot flow through the inner lumen48 when the plug 60 is disposed therein. The inner lumen 48 in thisillustrated embodiment has a cylindrical shape and a circularcross-sectional shape, so the plug 60 has a corresponding cylindricalshape and circular cross-sectional shape. The plug 60 has a length thatis less than a length of the inner lumen 48, as shown in FIG. 6, whichmay make the plug 60 easier to remove from the inner lumen 48.

The plug 60 is configured to be removed from the inner lumen 48 at theselected time to move the implant 46 from the first configuration to thesecond configuration. The plug 60 is attached to a suture 62 thatextends proximally therefrom, and hence extends proximally from theimplant 46. The suture 62 is configured to be manipulated by a user(e.g., a surgeon, a nurse, etc.), e.g., pulled in a proximal direction,to remove the plug 60 from the inner lumen 48. The suture 62 has alength that is long enough to allow the suture 62 to extend from theplug 60 implanted in a body of a patient and through a skin of thepatient such that a proximal portion of the suture 62 is located outsideof the patient. The suture 62 can thereby be manipulated from outsidethe patient's body to remove the plug 60 from the inner lumen 48, e.g.,by pulling on the proximal portion of the suture 62, and allow blood toflow through the implant 46. The suture 62 can be trimmed in lengthoutside of the patient's body such that only a short length of suture islocated outside the patient's body, which may help prevent the suture 62from being accidentally pulled before the selected time, even if theproximal portion of the suture 62 is covered on the patient's skin, suchas with a bandage.

The suture 62 can be attached to the plug 60 in any of a variety ofways, e.g., being molded therein, by being glued thereto with adhesive,by being heat-melted thereto, by being tied thereto, etc. The suture 62includes a single strand, but in other embodiments a suture attached toa plug can include multiple strands. The plug 60 is attached to only onesuture 62, but in other embodiments, a plug can be attached to multiplesutures that each extend proximally from the plug and is configured tobe manipulated to remove the plug from the implant.

In an exemplary embodiment, the plug 60 is made from a non-bioabsorbablematerial (a single material or a combination of multiple materials) suchthat the plug 60 is non-bioabsorbable, and the suture 62 is made from anon-bioabsorbable material (a single material or a combination ofmultiple materials) such that the suture 62 is non-bioabsorbable. Theinner lumen 48 may thus become unoccluded at a selected time, e.g., theimplant 46 can be moved from the first configuration to the secondconfiguration at a selected time, thereby allowing the time to beselected by a doctor or other medical professional as desired for theparticular patient in which the implant 46 is implanted based on any oneor more factors, such as the patient's medical history, thedoctor's/professional's personal preference, etc. In other embodiments,the plug 60 and/or the suture 62 can be made from a bioabsorbablematerial (a single material or a combination of multiple materials) soas to be bioabsorbable. The plug 60 and suture 62 being bioabsorbableallows the plug 60 and suture 62 to be removed from the inner lumen 48at a selected time before a known absorption time of the plug 60 andsuture 62 or to be left in the inner lumen 48 to dissolve within thepatient's body at the known absorption time.

In another embodiment, an implant similar to the implant 46 of FIG. 5has a plug partially disposed in an inner lumen of the implant andextending proximally beyond the implant's proximal end. The plug has alength that is long enough to allow the plug to extend from the plugimplanted in a body of a patient and through a skin of the patient suchthat a proximal portion of the plug is located outside of the patient.The plug is configured to configured to be manipulated by a user (e.g.,a surgeon, a nurse, etc.), e.g., pulled in a proximal direction, toremove the plug from the inner lumen of the implant. Thus, instead ofhaving a suture attached thereto like the plug 60 and the suture 62 ofFIGS. 5 and 6, the plug itself is configured to extend from thepatient's body to allow removal of the plug from the implant's innerlumen to begin blood flow therethrough. In an exemplary embodiment, theplug is made from a knitted material configured to narrow in diameterwhen pulled so as to allow the plug to occlude the implant's inner lumen(e.g., in a first configuration of the implant) and then, when pulled,unravel to narrow in diameter and not occlude the implant's inner lumen(e.g., in a second configuration of the implant) and be removed from theinner lumen. The plug can thus be configured to be pulled out of thepatient's body through the patient's skin with the plug in its unraveledstate.

FIGS. 7 and 8 illustrate another embodiment of an implant 64 configuredto be implanted in bone and to delay clotting of blood flowing from thebone. The implant 64 is a tubular member in the form of a tube. Theimplant 64 is generally configured and used similar to the implant 10 ofFIG. 1, e.g., includes an inner lumen 66 defined by a solid innersurface (obscured in FIGS. 7 and 8) of the implant 64 and aligned with alongitudinal axis A3 of the implant 64, a proximal retaining member 68in the form of a flange, a distal retaining member 70 in the form of aring-shaped protrusion, an angled distal end 72, and an anti-coagulationagent in the form of a coating that coats an entirety of the implant'sexposed surface.

The implant 64 is configured to be implanted in a patient in a firstconfiguration in which the inner lumen 66 is occluded such that fluidcannot flow therethrough and to be moved after the implantation from thefirst configuration to a second configuration in which the inner lumen66 is at least partially unoccluded such that fluid can flowtherethrough. The first configuration of the implant 64 is similar tothe first configuration of the implant 46 of FIG. 5 in that fluid cannotflow through open proximal and distal ends of the implant 64 in thefirst configuration due to the occlusion. The second configuration is atransitional state in which the occlusion gradually dissipates such thatthe inner lumen 66 becomes more unobstructed over time such that morefluid can flow through the inner lumen 66 over time. Eventually, theinner lumen 66 becomes fully unoccluded in the second configurationsimilar to the second configuration of the implant 46 of FIG. 6.

As shown in FIG. 7, the inner lumen 66 of the implant 64 is occluded bya plug 74 that is at least partially disposed in the inner lumen 66. Theplug 74 is fully contained within the inner lumen 66 in this illustratedembodiment, but similar to that discussed above regarding the plug 60 ofFIGS. 5 and 6, in other embodiments, a plug can be partially outside ofan implant. The plug 74 is made from a bioabsorbable material (a singlematerial or a combination of multiple materials) so as to bebioabsorbable. The plug 74 is thus configured to dissolve within apatient's body so as to gradually dissipate from within the inner lumen66 at a known absorption time accordingly to a known absorption rate ofthe material(s) forming the plug 74. FIG. 8 shows a plurality of areas(six) in the plug 74 in which material forming the plug 74 has dissolvedto allow fluid flow, as shown by directional arrows 76. The plug 74being bioabsorbable allows the plug 74 to fully dissolve within thepatient's body, as opposed to remaining the patient's body until suchtime it is manually removed therefrom, which may subject the patient tovarious risks such as injury from a loose plug within their body. Theplug 74 being bioabsorbable allows the inner lumen 66 to becomeunoccluded at a predictable time post-surgery since an absorption rateof the material(s) forming the plug 74 will be known. A rate of theplug's absorption can be tailored based on a size of the plug 74, a size(length and/or diameter) of the inner lumen 66 in which the plug 74 isat least partially disposed, and a type of bioabsorbable materialforming the plug 74 since different materials can absorb at differentrates.

In another embodiment, an implant similar to the implant 64 of FIG. 7has a plug that is at partially disposed in an inner lumen of theimplant, but the plug is formed of a material configured to be activatedby energy to move the implant from a first configuration in which theinner lumen is occluded to a second configuration in which the innerlumen is unoccluded. The material can be activated by the energy at aselected time after the implantation of the implant in a patient asselected by a doctor or other medical professional as desired based onany one or more factors, such as the patient's medical history, thedoctor's/professional's personal preference, etc.

In an exemplary embodiment, the energy-activatable material forming theplug includes a material (a single material or a combination of multiplematerials) configured to be activated by ultrasonic energy, such ashigh-energy focused ultrasound (HIFU) or a magnetic field for a magneticmaterial, such as pulsed electromagnetic field therapy (PEMF). Ingeneral, HIFU is a technique that locally heats an area within apatient's body, as will be appreciated by a person skilled in the art.This heating can cause the plug to dissolve and thereby unocclude theimplant's inner lumen. Heating or ablation volumes using HIFU aretraditionally on the order of 1 mm in diameter, which would becompatible with the implant. Examples of material configured to beactivated by ultrasonic energy include a biomaterial configured to beshrunk by heating (such as a collagen-based structure), a polymer (suchas polycaprolactone, which has a melting point of about 60 degreesCelsius), a foamed polymer configured to decrease in volume when heated,and a shape memory material (polymer or metal). The shape memorymaterial can be configured to act as a valve within the implant's innerlumen by changing shape when activated by the energy.

An amount of energy required to dissolve the plug can vary, such as in arange of about 1 to 2 Joules. If the plug includes a thin membraneextending across the inner lumen, includes liquid to be heated to expandenough to break a seal, or to cause a shape memory material valve toopen, the energy can be less than 1 Joule, and in at least some cases,substantially less than 1 Joule.

In at least some embodiments, the energy-activatable material formingthe plug includes one or more cavities therein that each have containedtherein an anti-coagulating agent. The implant can thus include ananti-coagulating agent in the one or more cavities and, optionally, asany one or more of a coating on at least a portion of the implant,natural to a material forming at least a portion of the implant, andimpregnated into a material forming at least a portion of the implant.The anti-coagulating agent can be configured to be released from the oneor more cavities when the energy-activatable material is activated.

In at least some embodiments, the plug formed of the energy-activatablematerial is in the form of a proximal cap sealing a proximal end of theinner lumen and a distal cap sealing a distal end of the inner lumen. Ananti-coagulating agent is contained within the inner lumen between theproximal and distal caps. The implant can thus include ananti-coagulating agent in the inner lumen and, optionally, as any one ormore of a coating on at least a portion of the implant, natural to amaterial forming at least a portion of the implant, and impregnated intoa material forming at least a portion of the implant. Theanti-coagulating agent can be configured to be released from the innerlumen when the energy-activatable material is activated to disrupt theproximal and distal caps either by pressure build-up in the inner lumenand/or the energy causing the proximal and distal caps to break.

FIG. 9 illustrates another embodiment of an implant 78 configured to beimplanted in bone and to delay clotting of blood flowing from the bone.The implant 78 is in the form of an anchor configured to be implanted inbone and having an inner lumen extending therethrough (e.g., the anchoris cannulated). Surgical procedures such as soft tissue repairprocedures traditionally use one or more anchors as part of theprocedure. For example, the rotator cuff repair of FIGS. 3 and 4 usesanchors, as mentioned above. Any or all of the one or more anchors usedin the surgical procedures such as soft tissue repair procedures can bethe implant 78 (or other implant in the form of an anchor describedherein). The surgical procedure thus need not be performed anydifferently than traditionally performed except that the anchor(s)include an anti-coagulating agent to delay clotting of blood flowingfrom the bone and, optionally, bone need not be decorticated, scuffed,or microfractured to induce blood flow. The benefits of delayed bloodclotting may thus be achieved without any disruption to a surgeon'spreferred surgical procedure technique. The anti-coagulation agent iscoated on the implant 78 in the illustrated embodiment. The coating ispresent on an entire surface of the implant 78, but as mentioned above,the coating can be on only a portion of the implant 78, e.g., a portionin which flowing blood is expected to flow on. However, as mentionedabove, the implant 78 can instead or additionally have ananti-coagulation agent coated thereon (either on an entirety of theimplant's exposed surface or on only a portion thereof), as natural to amaterial forming the anchor, and/or impregnated into a material formingthe anchor.

As shown in FIG. 9, the implant 78 has an opening formed through asidewall thereof. The opening is in communication with an inner lumen ofthe implant 78 through which fluid (e.g., blood) can flow. Fluid canthus flow into the inner lumen through the opening. The opening islocated in an intermediate location of the implant 78 between proximaland distal end thereof. The proximal end of the implant 78 is open, andthe distal end of the implant 78 is closed such that fluid entering theinner lumen through the opening can flow proximally and out of the openproximal end of the implant 78. The opening in this illustratedembodiment includes two openings on opposite sides of the implant 78(one of the openings is obscured in FIG. 9), but an implant can includea single opening or more than two openings.

FIG. 9 illustrates the implant 78 implanted in a humerus 80 of a patient82 in rotator cuff repair, but as mentioned above, the implant 78 can beused in other types of surgical procedures. Only one of the implants 78is implanted in the bone 80, but as mentioned above, more than oneimplant can be implanted.

As shown in FIG. 9, the anchor 78 is secured to the rotator cuff tendon84 with a suture 86. The suture 86 can include an anti-coagulation agentcoated thereon (either on an entirety of the suture's exposed surface oron only a portion thereof), as natural to a material forming the suture86, and/or impregnated into a material forming the suture 86. Thus, boththe anchor 78 and the suture 86 can be configured to contribute todelayed blood clotting. Sutures used to secure other anchors used in thesurgical procedure can similarly include an anti-coagulation agentcoated thereon, as natural to a material forming the suture, and/orimpregnated into a material forming the suture.

In this illustrated embodiment, the suture 86 is configured to slidethrough the inner lumen of the anchor 78. The inner lumen is thusunoccluded, similar to the inner lumen 12 of the implant 10 of FIG. 1,to facilitate the suture's sliding therein. In embodiments of anchorsthat are used with a suture that does not slide within an inner lumen ofthe anchor (e.g., the anchor is used with a non-sliding suture), theinner lumen of the anchor can have a plug at least partially disposedtherein similar to the bioabsorbable plug 74 of FIG. 7, and the anchorand/or the plug can include an anti-coagulating agent, as discussedabove.

The anchor 78 is one embodiment of an anchor that includes ananti-coagulation agent. Other exemplary embodiments of anchors that caninclude an anti-coagulation agent coated thereon (either on an entiretyof the implant's exposed surface or on only a portion thereof), asnatural to a material forming the anchor, and/or impregnated into amaterial forming the anchor include the Healix Advance™ anchor availablefrom DePuy Mitek of Raynham, Mass., Healix TI™, Healix PEEK™, and HealixBR™ Dual-Threaded anchors available from DePuy Mitek of Raynham, Mass.,Healix Transtend™ anchor available from DePuy Mitek of Raynham, Mass.,Versalok™ anchor available from DePuy Mitek of Raynham, Mass., theanchors described in U.S. Pat. No. 8,114,128 entitled “Cannulated SutureAnchor” filed Nov. 1, 2006, the content of which is hereby incorporatedby reference in its entirety, and the anchors described in U.S. Pat. No.8,702,754 entitled “Methods For Anchoring Suture To Bone” filed Sep. 14,2007, the content of which is hereby incorporated by reference in itsentirety.

A person skilled in the art will appreciate that the methods, systems,and devices disclosed herein have application in conventionalminimally-invasive and open surgical instrumentation as well applicationin robotic-assisted surgery.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1.-3. (canceled)
 4. A surgical method, comprising: forming a hole in abone of a patient in a soft tissue repair procedure; implanting animplant in the hole, the implant including an anti-coagulation agent,wherein the implant is a tubular member, and an inner lumen of thetubular member is occluded when the implant is implanted in the holesuch that the blood is prevented from flowing through the implantedimplant until a selected amount of time has lapsed after completion ofthe soft tissue repair procedure, and wherein the implant has a sutureextending therefrom; and pulling the suture from outside the patient'sbody and thereby removing a plug from the inner lumen of the tubularmember.
 5. (canceled)
 6. The method of claim 16, wherein the implantincludes a retaining member configured to engage the bone in which theimplant is implanted to retain the implant within the bone. 7.-9.(canceled)
 10. The method of claim 16, wherein the implant isbioabsorbable.
 11. The method of claim 16, wherein the implant is notbioabsorbable.
 12. (canceled)
 13. The method of claim 16, wherein theanti-coagulation agent is coated on a surface of the implant.
 14. Themethod of claim 16, wherein the anti-coagulation agent is impregnated ina material forming the implant.
 15. The method of claim 16, wherein theanti-coagulation agent includes at least one of heparin, heparinsulfate, warfarin, hirudin, hirulog, coumarin, phosphorylcholine,indiandione, antithrombin III, bemiparin, dalteparin, danaparoid,enoxaparin, nadroparin, parnaparin, reviparin, sulodexide, tinzaparin,anticoagulant citrate dextrose solution A (ACD-A),ethylenediaminetetraacetic acid (EDTA), citrate, oxalate, a factor Xainhibitor, and a thrombin inhibitor.
 16. A surgical method, comprising:forming a hole in a bone of a patient in a soft tissue repair procedure;implanting an implant in the hole, the implant including ananti-coagulation agent, wherein the implant is a tubular member, and aninner lumen of the tubular member is occluded when the implant isimplanted in the hole such that the blood is prevented from flowingthrough the implanted implant until a selected amount of time has lapsedafter completion of the soft tissue repair procedure, and wherein theimplant includes a knitted material that occludes the inner lumen; andpulling the knitted material after the selected amount of time haselapsed to cause the knitted material to unravel.
 17. The method ofclaim 16, wherein the implant is an anchor, and the anchor has at leastone bone-engaging surface feature on an exterior surface thereof thatengages the bone to secure the anchor in the hole. 18.-19. (canceled)20. The method of claim 16, further comprising implanting an anchor inthe bone at a site a distance away from a site where the implant isimplanted, wherein the implant is a tubular member that is not connectedto the anchor with any implanted matter.
 21. (canceled)
 22. The methodof claim 4, wherein the implant is made from an energy activatedmaterial disposed therein that occludes the inner lumen, and the methodfurther comprises, after the selected amount of time has elapsed,activating the energy activated material by application of energythereto.
 23. The method of claim 4, wherein the implant includes aretaining member configured to engage the bone in which the implant isimplanted to retain the implant within the bone.
 24. The method of claim4, wherein the implant is bioabsorbable.
 25. The method of claim 4,wherein the implant is not bioabsorbable.
 26. The method of claim 4,wherein the anti-coagulation agent is coated on a surface of theimplant.
 27. The method of claim 4, wherein the anti-coagulation agentis impregnated in a material forming the implant.
 28. The method ofclaim 4, wherein the anti-coagulation agent includes at least one ofheparin, heparin sulfate, warfarin, hirudin, hirulog, coumarin,phosphorylcholine, indiandione, antithrombin III, bemiparin, dalteparin,danaparoid, enoxaparin, nadroparin, parnaparin, reviparin, sulodexide,tinzaparin, anticoagulant citrate dextrose solution A (ACD-A),ethylenediaminetetraacetic acid (EDTA), citrate, oxalate, a factor Xainhibitor, and a thrombin inhibitor.
 29. The method of claim 4, whereinthe implant is an anchor, and the anchor has at least one bone-engagingsurface feature on an exterior surface thereof that engages the bone tosecure the anchor in the hole.
 30. The method of claim 4, furthercomprising implanting an anchor in the bone at a site a distance awayfrom a site where the implant is implanted, wherein the implant is atubular member that is not connected to the anchor with any implantedmatter.